Following the RCP’s submission to the government’s 10-Year Health Plan, RCP officers set out their thoughts on the three ‘shifts’ proposed in the plan: sickness to prevention, hospital to community, and analogue to digital. In this piece, Dr John Dean, RCP clinical vice president, focuses on the hospital to community shift.
The NHS is at a turning point. Faced with an ageing population, increasing healthcare demands, and workforce challenges, the 10-year plan proposes a bold vision to address these pressures by shifting care from hospitals to communities.
While not a new ambition of healthcare policy this shift represents an opportunity to deliver care that is more patient-centred, equitable and sustainable. It must not be merely a reorganisation of services or expansion of more of the same; if it is to be truly transformational, it has to be a rethinking of healthcare delivery. By better integrating primary, community and specialist care, alongside a reimagining of outpatient services, we can ensure that patients receive timely, high-quality care closer to home – vital to our shared ambition of reducing delays, and improving outcomes given that so many people on waiting lists are waiting for an outpatient appointment. We cannot focus on waiting list waits at the expense of other vital reforms being overlooked, including in outpatient services and social care. The NHS milestone for reducing delays set out by the prime minister last week will not be reached if the current models of care remain.
The RCP has long championed an integrated approach, with initiatives like Teams without Walls, the Future Hospital Commission, and Future Hospitals Programme. Many services have demonstrated that integrating specialist services with community and primary care leads to better patient outcomes, reduces duplication of care, and can focus resources on interventions with the greatest impact.
Though often thought of as ‘hospital doctors’, physicians work in the community too. We have played a crucial role in developing and delivering community-based specialist services, with fields like geriatrics, palliative medicine, diabetes, respiratory, cardiology, musculoskeletal, and dermatology all pioneering models of integrated care. However, these initiatives have struggled to achieve widespread implementation due to financial barriers, fragmented care structures, and limited training opportunities.
We welcome the government’s confirmation that it will refresh the NHS Long Term Workforce Plan next summer following the publication of the 10-year plan as we’d called for. That sequencing will ensure that we have the workforce needed to deliver the government’s plans and meet patient need.
Physicians and their teams have a key role in providing community care in redesigned outpatient care, and urgent and emergency care and supporting primary care teams with patients who have key conditions and complex needs. However, they are constrained from doing so currently by financial flows, workforce gaps and training capacity and opportunities. For a successful hospital to community shift, the expansion of postgraduate medical specialty places alongside growing general practice and primary care roles will be key. The government’s focus on neighbourhood health offers a chance for more radical change, where the expertise of specialists combines with community and primary care to meet patients' needs holistically.
We are pleased that the UK government intends to ‘transform the model of care’ with a focus on prevention and dealing with health issues earlier when they are easier to treat or cure.
To fully realise this vision, physicians should be recognised as:
- neighbourhood champions for specific conditions or high-risk populations
- local experts providing advice to patients and health professionals
- collaborators delivering specialty care alongside primary and community teams
- translators of research into practice for specific conditions
- educators training primary and community healthcare professionals.
Our newly published Modern outpatient care guide for regional and local teams is the first in a series of RCP thought leadership pieces on how to reform outpatient services so that they work better for patients. Traditional models of appointment-based, siloed care must give way to new holistic, integrated approaches. The RCP’s vision for outpatient care transformation highlights several critical shifts, including:
- moving from difficult-to-navigate systems to streamlined pathways closer to home
- prioritising prevention and shared decision-making tailored to individual needs
- integrating care across specialties and settings, reducing duplication and improving outcomes.
Modern outpatient care should involve multiprofessional teams and diverse consultation methods, from face-to-face to remote and group sessions. By breaking care into stages – such as diagnosis, prevention, monitoring, and ongoing support – we can ensure better alignment with community health services.
In addition, the Hospital at Home model, allows acute hospital-level care to be delivered in a patient’s home or community setting, offering services such as consultant-led daily reviews, blood tests, intravenous therapies, and oxygen treatment, and continuous monitoring and rapid escalation of care when needed. For some patients – especially those nearing the end of life – this approach provides care that is not only clinically effective but also compassionate and dignified. However, scaling up this model requires significant investment in workforce training and capacity. The RCP strongly urges the use of the term ‘Hospital at Home’ rather than ‘virtual ward’ to avoid confusion among patients and families, ensuring that these services are seen as comprehensive and high-touch, rather than purely remote or digital.
The 10-year plan represents a unique opportunity to reshape healthcare delivery in the UK. By working together – clinicians, policymakers, and communities – we can create a system that delivers better outcomes, improves patient experiences, is rewarding for clinicians, and ensures the sustainability of the NHS for generations to come.
Read the RCP’s response to the government consultation on its 10-year plan for the NHS here.
Read the RCP’s response to the government’s confirmation that it will refresh the NHS Long Term Workforce Plan in 2025 here.
Dr John Dean
Clinical vice president
